卵圆孔未闭伴房间隔膨出瘤与先兆偏头痛关系的超声心动图研究  

An echocardiographic study of the relationship between patent foramen ovale with atrial septal bulging tumor and migraine aura

作　　者：杨娟[1] 赵娜[1] 齐清华[1] YANG Juan;ZHAO Na;QI Qinghua(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2021年第24期2160-2167,共8页Chinese Journal of Practical Nervous Diseases

摘　　要：目的应用经食管超声心动图(transesophageal echocardiograghy,TEE)联合右心声学造影评估卵圆孔未闭(patent foramen ovale,PFO)伴房间隔膨出瘤(atrial septal aneurysm,ASA)与先兆偏头痛(migraine with aura,MA)的关系。方法回顾性分析郑州大学第一附属医院2018-01—2021-05接受经食道超声心动图联合右心声学造影的988例患者的检查图像及临床资料。超声检查前,采用经过验证的头痛问卷,由两位神经科医生根据国际头痛标准诊断是否有先兆偏头痛,由超声医生在不知患者是否有偏头痛的前提下进行超声心动图检查,进行RLS分级,对无FPO和ASA组、PFO组、ASA组和PFO伴ASA组进行偏头痛及先兆偏头痛的单因素分析,并对有无先兆偏头痛患者的RLS分级进行比较。结果孤立的PFO占15.38%,孤立的ASA占3.04%,PFO合并ASA占7.29%。偏头痛发生率19.03%,MA发生率8.20%。与无PFO和ASA组比较,PFO伴ASA组无先兆偏头痛(OR=2.324,95%CI:1.225-4.41,P=0.008)及有先兆偏头痛(OR=5.533,95%CI:3.031-10.1,P<0.001)患病率显著增高。偏头痛患者中,PFO伴ASA组有先兆发生的患病率显著增高(OR=2.381,95%CI:1.095-5.176)。在RLS分级中,2级和3级分流在MA及MA—患者之间差异有统计学意义(χ^(2)=7.912,P=0.005);PFO伴ASA组2级和3级分流显著高于PFO组(χ^(2)=7.023,P=0.008)。结论 PFO合并ASA与MA显著相关,且出现右向左分流的程度增高,PFO引起的偏头痛研究应集中于这种特殊的心房异常。Objective To evaluate the relationship between patent foramen ovale(PFO) with atrial septal aneurysm(ASA) and migraine with aura(MA) by transesophageal echocardiography(TEE) combined with contrast echocardiography.Methods The examination images and clinical data of 988 patients who underwent transesophageal echocardiography combined with right heart sonography in the First Affiliated Hospital of Zhengzhou University from January 2018 to May 2021 were analyzed retrospectively.Before the ultrasonic examination,the patients were treated with a validated headache questionnaire,and diagnosed by two neurologists to determine whether there was migraine aura according to the international headache standards.The ultrasonic doctor examined the patient by echocardiography without knowing whether the patient had migraine and RLS classification was conducted.Single factor analysis of migraine with aura and migraine without aura was performed in non FPO and ASA group,PFO group,ASA group and PFO with ASA group.RLS classification of migraine with aura group and migraine without aura group were compared.Results Isolated PFO accounted for 15.38%,isolated ASA accounted for3.04%,and PFO combined ASA accounted,for 7.29%.The incidence of migraine was 19.03%,and the incidence of MA was 8.20%.Compared with the without PFO and ASA,the prevalence of migraine without aura(OR=2.324,95% CI:1.225-4.41,P=0.008) and migraine with aura(OR=5.533,95% CI:3.031-10.1,P<0.001) in PFO with ASA group were significantly higher.Among migraine patients,the prevalence of aura in PFO with ASA group was significantly higher(OR=2.381,95% CI:1.095-5.176).In RLS grading,grade 2 and grade 3 shunts were statistically different between MA and non-MA patients(χ^(2)=7.912,P=0.005).The grade 2 and 3 shunts of PFO with ASA were significantly higher than those of patients with PFO alone(χ^(2)=7.023,P=0.008).Conclusion PFO combined with ASA is significantly correlated with MA,and the degree of right to left shunt is increased.The study of migraine caused by PFO should

关 键 词：偏头痛 右心声学造影 经食管 卵圆孔未闭 房间隔膨出瘤 

分 类 号：R747.2[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]